Is 24 hour care worse than none at all?

My Aunty’s neighbours were a couple of sisters whom I knew from very small from our frequent family visits. they were always part of the catch up conversations and would turn up at big occasions too. Only recently one of them died. the GP had apparently described them as a couple of bean poles holding each other up. The surviving sister was quite frail and by now had marked memory problems but over the years (decades in fact) the neighbours had formed a very supportive relationship. My Aunty would go in regularly as would other neighbours. A strong informal network had been built up. She was also receiving a home care package. i understand this had the hallmarks of one of those classic hit and miss visits, where sometimes she had got herself up or didn’t need help at that particular time. the lady did have a fall one day and was admitted briefly to hospital. My Aunty called me up to report that the house had been sold and the lady had been moved into a care home. Obviously the experts had decided with the family that the risk of her being at home alone was too great as she could be found at the bottom of the stairs any day. A few weeks later I spoke to my aunty again. this time she was distraught. she had been to visit her old neighbour who had been in care for 6 weeks now. ‘Oh Damian, it was awful. She’s a shadow of what she was. she has lost huge amounts of weight (she was always very slim anyway) and looks like she’s given up.’ I reflected upon this as something I have seen all too often – the impact of a change and a move on a person with dementia. Why do we still not put the potential damage to welbeing into the equation when weighing up the pros and cons of going into care? But who would dare advocate this woman staying in her own home with an unworkable home care package? Who would want the come back of this lady perhaps being found at the bottom of her stairs one day? The brilliantly written ‘A Better Life:Valuing Our Later Years’ (recently published by the Joseph Rowntree Foundation) gives us a pointer:

‘current social work practice focusses more on assessing the risk, dependence and vulnerability of older people than on looking at their strengths, resources and aspirations’ 

When I put the phone down I immediately what a sad indictment that in this case 24 hour care proved to be worse than no care at all. On further reflection I realised that there was indeed a care package of sorts – not the means tested, limited-scope local authority or care agency package but the rich resource of neighbours and friends who had become increasingly supportive over the years and moreso recently. Neighbours and small street communities are an untapped and underestimated resource (A Better Life also highlights this) and need to be more closely looked at to put the breaks on what some would say has become an over regulated risk-averse litigious culture we work in. this lady’s case cannot be isolated.  No doubt many similar cases are rationalised by ‘experts’ as ‘well  she was obviously deteriorating more rapidly than we thought’. (bit of a chicken and egg situation there!) Currently there are clearly too many people in the same situation – perhaps seen as too vulnerable in the community yet clearly not ill enough to be subject to large scale long term care settings. Let’s tap into those rich community resources and move away from the asylum model of care (lots of people under one roof) that is too conveniently seen as the safe option. Safe for whom?